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| __NOTOC__
| | #Redirect [[Neutropenia causes]] |
| {{Agranulocytosis}}
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| {{CMG}}
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| ==Overview==
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| ==Causes==
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| A large number of drugs<ref>[http://www.annals.org/cgi/reprint/146/9/657.pdf Systematic Review: Agranulocytosis Induced by Nonchemotherapy Drugs], Ann Intern Med. 2007;146:657-665</ref>
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| have been associated with agranulocytosis, including [[Albendazole]], [[Metoclopramide]], [[spironolactone]], [[antiepileptic]]s, antithyroid drugs ([[carbimazole]], [[methimazole]], and [[propylthiouracil]]), antibiotics ([[Amoxicillin]], [[chloramphenicol]], [[co-trimoxazole]] and[[penicillin]]); cytotoxic drugs, [[hydroxychloroquine]]; gold; NSAIDs ([[diflunisal]], [[indomethacin]], [[naproxen]], [[phenylbutazone]], [[metamizole]]), [[mebendazole]]; the antidepressant [[mirtazapine]], [[tolbutamide]], [[Hydrocodone bitartrate and acetaminophen]] and some [[antipsychotic]]s [[Chlorpromazine]], [[Cirofloxacin]] (the atypical antipsychotic [[quetiapine]], [[clozapine]]<ref>Diaz, Jaime. How Drugs Influence Behavior. Englewood Cliffs: Prentice Hall, 1996.</ref>). Clozapine users in the US and Canada must be nationally registered for monitoring of low WBC and absolute neutrophil counts (ANC).
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| Although the reaction is generally idiosyncratic rather than proportional, experts recommend that patients using these drugs be told about the symptoms of agranulocytosis-related infection, such as a sore throat and a fever.
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| The [[Centers for Disease Control]] recently traced outbreaks of agranulocytosis among [[cocaine]] users, in the US and Canada between March 2008 and November 2009, to the presence of [[levamisole]] in the drug supply. The [[Drug Enforcement Administration]] reported that, as of February 2010, 71% of seized cocaine lots coming into the US contained levamisole as a [[cutting agent]].<ref>U.S. Department of Justice, National Drug Intelligence Center, ''National Drug Threat Assessment 2010'', [http://www.justice.gov/ndic/pubs38/38661/drugImpact.htm#textbox1 Colombian Cocaine Producers Increase Use of a Harmful Cutting Agent], February 2010.</ref> Levamisole is an [[antihelminthic]] (i.e. deworming) drug used in animals. The reason for adding levamisole to cocaine is unknown,<ref>"Agranulocytosis Associated with Cocaine Use --- Four States, March 2008--November 2009." Centers for Disease Control: Morbidity and Mortality Weekly Report. December 18, 2009/Vol. 58/No. 49 [http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5849a3.htm] Cited in Hsu, Jeremy. "Majority of U.S. Cocaine Supply Cut with Veterinary Deworming Drug." Popsci.com. December 18, 2009. [http://www.popsci.com/science/article/2009-12/majority-us-cocaine-supply-cut-veterinary-deworming-drug]</ref> although it can be due to their similar melting points and solubilities.
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| ===Drug Causes===
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| * [[Chlordiazepoxide]]
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| * [[Isoniazid]]
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| *[[Meropenem]]
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| ==References==
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| {{Reflist|2}}
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| [[Category:Disease]]
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| [[Category:Hematology]] | |
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